Abstracts of the 2023 Pennsylvania College of Emergency Physicians Scientific Assembly

Study Objectives : The COVID-19 pandemic affected healthcare professionals across many specialties. This study provides a look into how sleep quality was affected during the pandemic across different primary specialties.

imaging tool that has numerous applications for patient care. Our health system has 2 out of only 47 hospitals who are nationally accred-   Results: From January 2021 to December 2021, there were 587 alerts, including 106 level 1, 468 level 2, and 13 pediatric trauma alerts trauma alerts. Our random sampling (goal 10 per month, see Table 1) found an overall FAST exam compliance of 99% with 98% accuracy. There was a single episode of documentation noncompliance in the first month of program implementation. Any inaccuracy in documentation was individually reviewed and re-education was given as needed. Only one technological error occurred with a single incident of failure to upload FAST images. We continue to review FAST compliance on a quarterly basis with continuous review for any mortality. Additional interdisciplinary education is conducted during the Department of Emergency Medicine Grand Rounds.
Conclusion: From confirming a diagnosis, to facilitating safe and effective procedures through superior visualization of a patient's anatomy, ultrasound is a versatile tool that should be used in the care of trauma patents. While ultrasound is a mainstay in the trauma bay for FAST exams, we found that a dedicated POCUS team resulted in overall improvements in FAST exam speed, documentation, and protocol compliance. Future efforts will focus on expanding our current program to other hospitals in our network. Methods: This is an analysis of prospectively collected data obtained in a separate study evaluating how patients experience their emergency care when learners are present. Trained medical student volunteers administered the survey to a convenience sample of patients slated for discharge at a single community tertiary care hospital for a total of 12 weeks between June 2022 to October 2022. We compared this with the hospital's PG data for the questions on which the survey was based (Table 1).

Conclusion:
This study shows a dramatically improved response rate to an in-person survey compared with mail in PG forms, increasing its validity and making data less susceptible to recall bias. Results of the key questions compare favorably. A 5-point difference in PG score could lead to a 30-point change in percentile rank. This is a limited, single site study whose results are hypothesis-generating but suggest a new pursuit for administrations seeking to truly understand their patients' experience of their care. Methods: This will be a prospective study using healthy volunteers who will have two 4 cm linear applications of skin glue placed on their forearm. One will have UV light applied to it (at 3-5 cm from skin) for 5 second intervals and after each interval the subject and 1 blinded investigator will mark on a visual analogue scale the "stickiness" of the glue. This will continue every 5 seconds until the glue is cured. The other line will have no intervention and at 5 second intervals the subject and a blinded investigator will mark on a visual analogue scale the "stickiness" of the glue. This will continue every 5 seconds until the glue is cured. The interventions will be randomly assigned and only the investigator administering the interventions will know which is being used. A barrier will be used to blind the other investigator and subject and prevent them from seeing which intervention is being used. Lastly, the subject will be asked which intervention they were most satisfied with and if there were any complaints or issues with the interventions. A task trainer for the management of auricular hematomas was created and subsequently evaluated by emergency medicine trainees, to augment learning related to the management of auricular hematomas.

Results
Methods: Surgical skin pads from procedural simulation mannequins were traced with a white charcoal pencil using an ear stencil, and then cut out from the pad. A knife blade was then used to make a perpendicular incision on the edge of the material and the space was widened between the two layers of the separated material. A piece of 2×2 cotton gauze was cut in half and placed into the pre-made incision to simulate a hematoma. The simulated ear was then tacked to a Styrofoam head with pushpins for use. A lecture on management of auricular hematomas was given prior to trainees simulating the procedure of incision and drainage of an auricular hematoma. The subcutaneous surgical skin pads (which created 10 reusable ears) and polystyrene foam head had an estimated cost of less than $100 if purchased new. A preand post-procedural simulation survey was created to identify current level of confidence with management of auricular hematomas and utility of the task trainer. Review by the institutional institutional review board (IRB) determined this project to be exempt.

F I G U R E 1
Performance on substance abuse screening from July to December 2020 compared to the recommended target of 80%.

F I G U R E 2
Performance on substance abuse screening from January to December 2021 compared to the recommended target of 80%.
Results: Pre-simulation survey using a 5-point Likert scale somewhat average lower confidence levels in managing an auricular hematoma prior to the simulation (2.1/5), which improved after the lecture and drainage simulation (4.23/5). Trainees thought a task trainer would teach the necessary procedural skills (4.75/5) and after using the task trainer, found the task trainer to be adequate (4.69/5). Qualitative evaluation of comments written on the post-survey found most all comments to be positive with mention of it being helpful. One comment suggested using more realistic ears. were Nurses, 101 were Attending Physicians and 59 were NP/PAs.

Results:
Results showed a difference in responses to four of the questions on the survey including "I have trouble falling asleep," "I have trouble staying asleep," "I am concerned about my financial situation," and "I am stressed at work." We observed a significant difference to each of these questions (See Figure 1)

Conclusion:
Sleep, financial concern, and stress from work can all contribute to a provider's care in the workplace. NPs/PAs suffer significantly greater than residents in training and attending physicians regarding having trouble falling asleep over the course of the COVID-19 pandemic. NPs/PAs also have a harder time staying asleep when compared to residents in training. When assessing a provider's financial concern, residents in training are more concerned than attending physicians and NPs/PAs, and nurses are also more concerned when compared to attending physicians and NPs/PAs. Finally, residents in training feel less stress at work than NPs/PAs. The wellness questionnaires allow us to assess the impact of the pandemic on providers across several job titles; our results contain a wide range of areas marking concern for wellness of providers, and this warrants further research into why or how these differences arise. Three patients returned to emergency department for evaluation of persistent fever. Conclusion: Development of a peritonsillar abscess task trainer with available legacy equipment was feasible. Based on structured feedback, using a peritonsillar abscess task trainer is a suitable strategy to augment learning and skill development for management of peritonsillar abscesses in emergency medicine trainees.  (1). International data reflects increased incidence of out of hospital cardiac arrest (OHCA), and lower rates of bystander interventions (1, 2). We sought to determine if the incidence of OHCA increased in 2020 in Pennsylvania relative to 2019. We hypothesized that avoidance of care would lead to decreased neurologically intact survival rates, fewer transports, and lower rates of bystander cardiopulmonary resuscitation (CPR) in the COVID era.

| PI Pathways for Monitoring Compliance in Trauma
Methods: A total of 13,346 cases were reviewed from the Cardiac Arrest Registry to Enhance Survival (CARES) database.
Descriptive statistics and appropriate comparative statistical techniques were performed under the guidance of professional statistician.    being completely true. Figure 1 indicates the median responses to the wellness questionnaire across the different age groups.

Conclusion:
The pandemic played a role in the overall perceived stress level in the healthcare workplace among providers of different ages.
Based on our study, the results indicate there is increased dread when "thinking about the work that needs to be done," among younger providers (younger than 60 years old). The perceived sense of dread over the difficulties experienced in the pandemic, specifically among younger providers, can potentially negatively affect the providers in ways that should prompt further investigation. Results: Thirteen attending physicians voluntarily participated. Twelve participants were emergency medicine and 1 was emergency and pediatric medicine. Sixty-two percent (N = 8) were male, and thirty-eight percent (N = 5) were female. The mean pre-test score was 8.385/12 or 69.8% and the mean post test score was 9.62/12 or 80%. Eightythree percent (N = 10) scored an 80% or greater on the post-test.
Sixty-nine percent (N = 9) improved their pre-test scores, 23% (N = 3) had no change in their score, and 8% (N = 1) had a decrease in their score. The majority (85%, N = 11) completed direct observation of the POCUS procedures, see Table 1 for an example observation rubric. Data was missing from 15% of the learners (N = 2) due to either abstention from observation or failure to submit their checklist. No learner required remediation for any of the exams that were proctored. Ninety-two (N = 12) of participants felt they were likely to expand their use and teaching of ultrasound on shift after this REE. All the participants (100%) felt that after this course they could procedurally meet the objectives taught during their next POCUS procedure on shift.
Conclusion: While most of the participants were able to meet course threshold scores, the objective of 90% of participants passing the posttest with greater than 80% was not achieved. However, nearly 2/3 of the participants were able to show improvement from pre-test scores.
The majority of participants did complete a directly observed procedure by faculty for the lung, echo, and Focused Assessment with Sonography for Trauma (FAST) exams, yet the goal of attaining 100% direct observation of each procedure by each participant was not completed. Evaluating learner preferences for being observed and more optimal data collecting strategies might improve these outcomes in F I G U R E 1 Median response values from providers of different age groups.